The use of Environmental Enrichment (EE) has been widely studied in animal models. However, the application of the same in humans is limited to rehabilitation settings.
To investigate the feasibility ...of a community-based EE paradigm in adults with brain injury.
Six individuals diagnosed with traumatic brain injury enrolled in the study. The Go Baby Go Café instrumented with a body weight harness system, provided physical and social enrichment as participants performed functional tasks for 2 hours, three times a week, for 2 months. Feasibility and safety outcomes were recorded throughout sessions. Clinical measures including 10-meter walk, timed up and go, jebsen hand function, 6-minute walk, and trail making tests were obtained pre and post intervention.
All participants completed the study. The attendance was 100% and adherence was 87%. Positive changes in clinical measures were statistically significant for the timed up and go (
= 0.0175), TUG-cognitive (
= 0.0064), 10-meter walk (
= 0.0428), six-minute walk (
= 0.0196), TMT-A (
= 0.034). Changes in JHFT were not significant (
= 0.0506), with one subject recording values counter to the trend.
The Café was a comprehensive EE-based intervention that was feasible, safe, and has the potential to enhance motor and cognitive function in individuals with brain injury.
The aim of this retrospective study was to determine the prevalence of orthostatic hypotension (OH) among a convenience sample of older adults on two Acute Care of the Elderly (ACE) units of the ...ChristianaCare™ in Delaware. Another aim was to determine if subjects with documented OH experienced falls. Retrospective de-identified data was obtained from electronic medical records for the years 2015 to 2018. Among all patients who had valid first orthostatic vital sign (OVS) readings (n = 7,745), 39.2% had orthostatic hypotension on the first reading. Among the patients, 42.8% were found to be hypotensive during OVS. Thirty-one (0.9%) of those with OH fell at some point during their stay. The odds ratio for falls in the presence of OH was 1.34 with a 95% confidence interval (0.82, 2.21), but a chi-square test failed to find significance (p = .2494). The results could not determine if OVS should be mandatory in fall prevention protocols.
Functional electrical stimulation systems are used as neuroprosthetic devices in rehabilitative interventions such as gait training. Stimulator triggers, implemented to control stimulation delivery, ...range from open- to closed-loop controllers. Finite-state controllers trigger stimulators when specific conditions are met and utilize preset sequences of stimulation. Wearable sensors provide the necessary input to differentiate gait phases during walking and trigger stimulation. However, gait phase detection is associated with inherent system delays. In this study, five stimulator triggers designed to compensate for gait phase detection delays were tested to determine which trigger most accurately delivered stimulation at the desired times of the gait cycle. Motion capture data were collected on seven typically-developing children while walking on an instrumented treadmill. Participants wore one inertial measurement unit on each ankle and gyroscope data were streamed into the gait phase detection algorithm. Five triggers, based on gait phase detection, were used to simulate stimulation to five muscle groups, bilaterally. For each condition, stimulation signals were collected in the motion capture software via analog channels and compared to the desired timing determined by kinematic and kinetic data. Results illustrate that gait phase detection is a viable finite-state control, and appropriate system delay compensations, on average, reduce stimulation delivery delays by 6.7% of the gait cycle.
Video- and sensor-based gait analysis systems are rapidly emerging for use in 'real world' scenarios outside of typical instrumented motion analysis laboratories. Unlike laboratory systems, such ...systems do not use kinetic data from force plates, rather, gait events such as initial contact (IC) and terminal contact (TC) are estimated from video and sensor signals. There are, however, detection errors inherent in kinematic gait event detection methods (GEDM) and comparative study between classic laboratory and video/sensor-based systems is warranted. For this study, three kinematic methods: coordinate based treadmill algorithm (CBTA), shank angular velocity (SK), and foot velocity algorithm (FVA) were compared to 'gold standard' force plate methods (GS) for determining IC and TC in adults (
= 6), typically developing children (
= 5) and children with cerebral palsy (
= 6). The root mean square error (RMSE) values for CBTA, SK, and FVA were 27.22, 47.33, and 78.41 ms, respectively. On average, GED was detected earlier in CBTA and SK (CBTA: -9.54 ± 0.66 ms, SK: -33.41 ± 0.86 ms) and delayed in FVA (21.00 ± 1.96 ms). The statistical model demonstrated insensitivity to variations in group, side, and individuals. Out of three kinematic GEDMs, SK GEDM can best be used for sensor-based gait event detection.
In the current study, we used functional near-infrared spectroscopy (fNIRS) to compare prefrontal cortex (PFC) activity in adults as they performed two conditions of the Tower of Hanoi (ToH) ...disk-transfer task that have equivalent executive function (EF) but different motor requirements. This study explored cognitive workload, here defined as the cognitive effort utilized while problem-solving by performance output. The first condition included a two-dimensional (2D) computerized ToH where participants completed trials using a computer mouse. In contrast, our second condition used a traditional, three-dimensional (3D) ToH that must be manually manipulated. Our aim was to better understand the role of the PFC in these two conditions to detect if PFC activity increases as a function of motor planning. Twenty right-handed, neurotypical adults (10M/10F,
= 24.6, SD ± 2.8 years old) participated in two blocks (one per condition) of three 1-min trials where they were asked to solve as many puzzles as possible. These data were analyzed using a mixed effects ANOVA with participants nested within blocks for 2D vs. 3D conditions, presentation order (leading block), individual participants, and regions and additional follow-up statistics. Results showed that changes in oxygenated hemoglobin, ΔHbO, were significantly higher for 3D compared to 2D condition (
= 0.0211). Presentation order and condition interacted significantly (
= 0.0015). Notably, a strong correlation between performance and ΔHbO existed between blocks 1 and 2 (
= -0.69,
= 0.473,
< 0.01) when the 3D condition was initially performed, in contrast to the 2D condition where no significant correlation was seen. Findings also showed a significant decrease in ΔHbO between the first and second block (
= 0.0015) while performance increased significantly for both 3D and 2D conditions (
< 0.005). We plan to use this information in the future to narrow the potential points of impairment on the perception-cognition-action continuum in certain developmental disabilities.
The study's objective was to determine whether variations in the 2013 American College of Cardiology/American Heart Association 10-year risk for atherosclerotic cardiovascular disease (ASCVD) were ...associated with differences in food consumption and diet quality. Findings from the baseline wave of Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study 2004-2009, revealed participants consumed a Western diet. Diet quality measures, specifically the Healthy Eating Index (HEI)-2010, Dietary Approaches to Stop Hypertension (DASH) diet and the Mean Adequacy Ratio (MAR), based on two 24-h recalls collected during follow-up HANDLS studies from 2009-2013, were used. Reported foods were assigned to 27 groups. In this cross-sectional analysis, the participants (
= 2140) were categorized into tertiles based on their 10-year ASCVD risk. Lower and upper tertiles were used to determine significantly different consumption rates among the food groups. Ten groups were used in hierarchical case clustering to generate four dietary patterns (DPs) based on group energy contribution. The DP with the highest HEI-2010 score included sandwiches along with vegetables and cheese/yogurt. This DP, along with the pizza/sandwiches DP, had significantly higher DASH and MAR scores and a lower 10-year ASCVD risk, compared to the remaining two DPs-meats/sandwiches and sandwiches/bakery products; thus, Western dietary patterns were associated with different levels of ASCVD 10-year risk.
The purpose of this study is to investigate whether a remotely delivered physical therapist intervention increases physical activity (PA) over 12 weeks, compared with existing web-based resources, in ...adults with knee osteoarthritis (OA).
This will be a single-center, randomized controlled trial with 2 parallel arms: (1) the Expanded Intervention (Delaware PEAK Physical Exercise and Activity for Knee osteoarthritis), which includes five 45- to 60-minute video conference-based sessions of supervised exercise (strengthening exercises, step goals) that are remotely delivered over 12 weeks by a physical therapist; or (2) the Brief Intervention (control group), a website that includes prerecorded videos directing participants to web-based resources for strengthening, PA, and pain management for knee OA that are freely available. The trial will enroll 100 participants who meet the National Institute for Health and Care Excellence OA clinical criteria (≥45 years old, have activity-related knee pain, and have no morning stiffness or it lasts ≤30 minutes), reside in the contiguous United States (excluding Alaska and Hawaii), and are seeking to be more physically active. Outcomes include PA (time in moderate-to-vigorous and light PA, steps per day), sedentary behaviors, treatment beliefs, and self-efficacy for exercise. Our primary outcome is moderate-to-vigorous PA. Outcomes will be measured at baseline, 12 weeks, and 24 weeks.
This protocol focuses on the remote delivery of physical therapy via telehealth to adults with knee OA and comes at a critical time, because the burden of inactivity is of particular concern in this population. If successful, the findings of this work will provide strong support for the broad implementation of Delaware PEAK, highlight the utility of telehealth in physical therapy, and address the critical need to utilize exercise to manage adults with knee OA through physical therapists.
Collegiate football players who started playing tackle football before age 12 years did not show worse neuropsychological test performance than those who started playing tackle football after age ...12 years. It is unknown if beginning other contact sports, such as lacrosse, at a younger age is associated with worse neurocognitive performance, greater psychological distress, or worse postural stability in collegiate student athletes.
The purpose of this study was to examine the association between estimated age of first exposure (eAFE) to repetitive head impacts (RHI) and these outcome measures in collegiate student athletes.
1891 female and 4448 male collision/contact (i.e., football, ice hockey, lacrosse, wrestling, soccer) and non-contact (i.e., golf, rifle, rowing/crew, swimming, tennis) sport athletes completed baseline testing, including the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT), Brief Symptom Inventory 18 (BSI-18), and Balance Error Scoring System (BESS).
For women, the eAFE-by-sport interaction was associated with ImPACT Verbal Memory and Visual Memory, whereby earlier eAFE to contact sports was associated with higher composite scores (B = - 0.397, B = - 0.485, respectively). For men, the eAFE-by-sport interaction was associated with BSI-18 Depression and Global Severity Index and symptom severity scores, whereby earlier eAFE to football was associated with lower psychological distress and symptom severity Depression, Exp(B) = 1.057; Global Severity Index, Exp(B) = 1.047; Symptom Severity, Exp(B) = 1.046. Parameter estimates were small suggesting these results may have minimal practical relevance.
Findings suggest that RHI during early adolescence is unrelated to brain health as measured by these specific outcome measures in collegiate student athletes.
Step counts, obtained via activity monitors, provide insight into activity level in the free-living environment. Accuracy assessments of activity monitors are limited among individuals with ...lower-limb amputations.
(1) To evaluate the step count accuracy of both monitors during forward-linear and complex walking and (2) compare monitor step counts in the free-living environment.
Cross-sectional study.
Adult prosthetic users with a unilateral transtibial amputation were equipped with StepWatch and FitBit One™. Participants completed an in-clinic evaluation to evaluate each monitor's step count accuracy during forward linear and complex walking followed by a 7-day step count evaluation in the free-living environment.
Both monitors showed excellent accuracy during forward, linear walking (intraclass correlation coefficients = 0.97-0.99, 95% confidence interval = 0.93-0.99; percentage error = 4.3%-6.2%). During complex walking, percentage errors were higher (13.0%-15.5%), intraclass correlation coefficients were 0.88-0.90, and 95% confidence intervals were 0.69-0.96. In the free-living environment, the absolute percentage difference between monitor counts was 25.4%, but the counts had a nearly perfect linear relationship.
Both monitors accurately counted steps during forward linear walking. StepWatch appears to be more accurate than FitBit during complex walking but a larger sample size may confirm these findings. FitBit consistently counted fewer steps than StepWatch during free-living walking. Clinical relevance The StepWatch and FitBit are acceptable tools for assessing forward, linear walking for individuals with transtibial amputation. Given the results' consistenty in the free-living enviorment, both tools may ultimiately be able to be used to count steps in the real world, but more research is needed to confirm these findings.
Purpose:
To describe items purchased during a shopping trip by families enrolled in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC).
Design:
Cross-sectional, ...quantitative, observational study.
Setting:
Grocery stores in the Newark, Delaware area.
Participants:
A convenience sample of mothers (n = 35) were recruited from a local WIC Clinic waiting room.
Measures:
The number of items categorized into 12 food groups, (baby food, beverages, dairy, fats/oils, fruit, vegetables, grains, protein, preprepared, seasonings, sweets, and other) extracted from grocery receipts.
Analysis:
Means and frequencies were used to analyze continuous and categorical data, respectively, for receipt data and demographics.
Results:
The most common foods purchased not included as part of the WIC food package included protein (1.0 standard deviation, SD 3.0), preprepared foods (0.9 SD 2.0), and other foods (1.0 SD 1.9). The most frequent foods purchased included as part of the WIC food package included fruit (2.3 SD 1.5), grains (1.7 SD 1.6), and dairy (1.5 SD 0.8).
Conclusions:
Further investigation of foods purchased that were not part of the WIC food package is warranted, as understanding food purchases particularly among low-income mothers may inform nutrition education practices.
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